74 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 Effectiveness of Autogenic Relaxation on Somatization Disorder and Biophysiologic Parameters among Chronic Disease Clients at Selected Villages, Thiruvallur District 1 B.Sc (N) IV Year Students (2012-2016 Batch), 2 Jayanthi P, 3 Hemavathy J, 4 Kanchana S, 5 Celina D 1 - B.Sc Students, Omayal Achi College of Nursing, Chennai, India 2 - Jayanthi P, Professor, Omayal Achi College of Nursing, Chennai, India 3 - Hemavathy J, Associate Professor, Omayal Achi College of Nursing,Chennai, India 4 - Kanchana S, Principal, Omayal Achi College of Nursing, Chennai, India 5 - Celina D, Vice Principal, Omayal Achi College of Nursing, Chennai, India ARTICLE INFORMATION Article History: Received : May 7 th 2017 Revised : - Accepted : May 25 th 2017 Corresponding Author: Jayanthi.P Email: ID: jayanthiarul2011 @gmail.com Mobile No: 9094144887 Abstract Objective: To assess the effectiveness of autogenic relaxation on somatization disorder and biophysiologic parameters among chronic disease clients. Materials and Methods: Aquasi-experimental study was conducted among 84 (42 - experimental group and 42 -control group) chronic disease clients who satisfied the inclusion criteria and were selected by non-probability convenient sampling technique. Researchers obtained written Informed consent and assessed the level of somatization disorder by using Patient Health Questionnaire 15 (PHQ-15). Samples were recruited from 5 villages adopted by Omayal Achi Community Health Centre. Autogenic relaxation intervention included physical exercise, deep breathing exercise, and emotional freedom technique administered to the samples for 2 weeks and post-test was conducted. Result : The findings of the study showed that in the experimental group, chronic disease clients had mild (45.23%), moderate (35.71%) and severe (19.06%) somatization disorder in pre-test and had no somatization (38.1%), mild (54.8 %) moderate (7%) somatization disorder in post-test. In control group, chronic disease clients had mild (45.23%), moderate (35.71%) and severe (19.06%) somatization disorder in pre-test and in post-test, chronic disease clients had mild (31%) moderate (40.5%) and severe (28.5%) somatization disorder. Hence, there is a reduction in overall somatization disorder among chronic disease clients. Conclusion: The study findings indicated that the autogenic relaxation technique was effective in the reduction of somatization disorder among chronic disease clients. Key words: autogenic relaxation, biophysiologic parameters, chronic disease clients, somatization disorder B.Sc (N) IV Year Students (2012-2016 Batch), Jayanthi P, Hemavathy J, Kanchana S, Celina D., Effectiveness of Autogenic Relaxation on Somatization Disorder and Biophysiologic Parameters among Chronic Disease Clients at Selected Villages, Thiruvallur District, ICCRJNR, Jan Jun 2017, 2(1): 74-80.
75 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 I Introduction A chronic disease is a sickness that lasts for a very long time and usually cannot be cured completely. People diagnosed with chronic disease must adjust to the demands of the illness itself, as well as the treatment for the condition. Some chronic diseases like hypertension and diabetes mellitus contribute to an increased risk of somatoform disorders. Somatic symptom is one of the most common issues in healthcare services and is associated with substantial functional impairment and healthcare utilization. Somatoform symptoms often account for sick leave and are characterized by a long duration of medically unexplained symptoms. Somatoform disorder is characterized by recurring multiple and current clinically significant complaints about somatic symptoms which are the leading causes of outpatient medical visits and also the predominant reason for anxiety. The most frequently reported symptoms are fatigue, low energy, sleeping trouble and pain [back pain, headache, abdominal pain, chest pain]. Although they are currently treated as both categorical and dimensional, little is known about the empirical latent structure of medically unexplained symptoms [1]. Somatic symptom disorder is also known as somatization disorder. In India, presently, 10% to 15% of people suffer from somatization disorder and the characteristic pattern of patients who present somatization disorder is one of frequently seeking and obtaining medical treatment for multiple and clinically significant somatic complaints. The course of the disorder is chronic and fluctuating, often associated with disruption of social, interpersonal and family behavior. Among the population, women are more likely than men to report somatoform disorders, depression and anxiety. Somatic presentations are the rule in routine clinical practice, and when physicians cannot find a pathological basis for them, they are referred to as somatization, somatoform disorders, medically unexplained symptoms, and functional somatic symptoms. This type of somatoform disorder usually begins before the age of 30 years. Clients with somatization disorder often experience frightening and intense emotions, which create anxiety and lead to defense mechanism to cope with anxiety. Blocking emotions, especially anger, rather than verbalizing them is commonly found in chronic disease with somatization disorder. Such patients can therefore be helped by having them experience and talk about their feelings and conflict. Autogenic relaxation package is a simple and cost effective intervention which helps to reduce the somatization disorder among chronic disease clients [2,3]. Somatization disorder plays a significant role in managing clients with chronic illness. The contribution of family, friends and community plays a major role in overcoming the somatic complaints. The client usually lacks awareness regarding the somatic symptoms; if the symptoms are known, they may have a positive attitude and help in preventing long term complications. In the somatoform disorders, physiologic changes are characterized by physical symptoms originating from emotional or mental sources.
76 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 II Materials and Methods A quasi-experimental non-equivalent control group design was adopted for the study. The study was conducted at 5 adopted villages of Omayal Achi Community Health Centre (OACHC), between September 2015 and August 2016. Ethical approval was obtained from the Institutional Ethics Review Board and formal permission was obtained from The Principal, Omayal Achi College of Nursing, The Centre Incharge of OACHC and the Village Leaders of the selected villages. Researchers selected the samples based on the Non-Probability convenient sampling technique. Chronic disease clients were selected based on the selection criteria of clients in the age group 40-60 years, who have diabetes mellitus or hypertension or both, and who had had illness for about 2 years and above. There were126 chronic disease clients who were screened for somatization disorder and the clients who got 5 and above in the Patient Health Questionnaire 15 [3,4] were selected for the study. Pair matching was done based on the level of somatization disorder and gender in each group. A total of 84 chronic disease clients were included in the study [42 in experimental group and 42 in control group]. A brief introduction about self and purpose of study was explained and written informed consent from chronic disease clients was obtained, confidentiality regarding the data was assured so as to get co-operation in the procedure of data collection. After getting the informed consent, data collection was carried out. The data collection procedure began with the collection of demographic variables of clients - age, gender, educational status, religion, type of family, marital status, nature of work, family monthly income, habits, type of family, kind of chronic disease and duration of chronic disease and then the somatization disorder of chronic disease clients was assessed by using Patient Health Questionnaire-15. In the experimental group, the chronic disease clients were invited and made to sit down on mats which were spread over the floor. Investigation of capillary blood glucose, blood pressure, weight, height and body mass index was assessed by using calibrated weighing machine, blood pressure apparatus and glucometer. On the same day, the investigator provided autogenic relaxation which included physical exercises, deep breathing exercises and video-assisted emotional freedom technique. This was given for a period of two weeks. Then, the chronic disease clients were made to re-demonstrate the autogenic relaxation. After two weeks, post-test was conducted by using the Patient Health Questionnaire-15 in both the experimental and control groups. Statistical analysis Statistical analysis was performed using the Statistical package for Social Sciences Programme (SPSS) version 17.0. Descriptive statistics was used to describe the demographic variables. Paired t test was used to compare the pre and post-test level of somatization disorder and biophysiologic parameters among chronic disease clients in the experimental and control group. Unpaired t test was used to compare the pre and post-test level of somatization disorder among chronic disease clients between the experimental and control group. One way ANOVA and F test was used to find the association between the level of somatization disorder, biophysiologic parameters and demographic variables. III Results 35.71% in the experimental group and 47.62% in the control group were in the age group of above 60 years, 11 (26.2%) chronic disease clients were male and 31 (73.8%) were female in both experimental and control groups. 38(90.5%) belonged to hindu religion in both the
77 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 experimental and control group. 27(64.2%) in the experimental group and 24(57.14%) in the control group were not literate. In the experimental group 29(69%) and in the control group 36(85.7%) of them were unemployed. 19(45%) of them had hypertension in the experimental group whereas 18(42.9%) of them had both hypertension and diabetes mellitus in the control group. 12(28.6%) in the experimental group were having the illness for the duration of 2 3 years whereas 11(26.2%) in the control group were having the illness for the duration of 4-5 years. The pre and post-test level of somatization disorder in the experimental and a control group is depicted in Figure 1 and 2. Comparison of pre-test and post-test biophysiologic parameters among chronic disease clients between the experimental and control group is depicted in Table 1 and 2. Fig 1: Percentage distribution of level of somatization disorder among chronic disease clients in experimental group Fig 2: Percentage distribution of level of somatization disorder among chronic disease clients in control group
78 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 The results revealed that in the experimental group, the pre-test mean score of somatization disorder was 10.90 with the SD of 3.99 and post-test mean score of somatization disorder was 5.88 with the SD of 2.52 (t=12.180, p=0.001). In the control group, the pre-test mean score of somatization disorder was 10.86 with the SD of 3.56 and post-test mean score of somatization disorder was 12.38 with the SD of 3.90 (t=-4.095, p=0.161). Table 1: Comparison of pre-test biophysiologic parameters among chronic disease clients between experimental and control groups N=84 Parameters Pretest Experimental Group Control Group Mean SD Mean SD BMI 128.88 35.10 142.64 56.0 Blood sugar 24.59 6.14 25.20 3.79 Blood pressure Systolic blood Diastolic blood *Significant at p 0.05 **highly significant at p 0.01 ***very high significant at p 0.001 140.23 10.47 137.61 12.25 84.76 10.87 82.14 10.48 Unpaired t Value t = -1.349 p = 0.182 t = -0.546 p = 0.587 t = 1.053 p = 0.296 t = 1.124 p = 0.264 Table 2: Comparison of post-test biophysiologic parameters among chronic disease clients between experimental and control group N=84 Parameters Post test Experimental Group Control Group Mean SD Mean SD BMI 114.33 36.51 150.07 56.79 Blood sugar 23.85 5.79 25.96 3.81 Blood pressure Systolic blood Diastolic blood *Significant at p 0.05 129.76 10.47 147.14 12.54 75.23 9.43 91.90 10.41 Unpaired t Value t = 3.430 p = 0.001 S** t = 1.877 p = 0.065 t = 6.891 p = 0.000 S*** t = 7.687 p = 0.000 S***
79 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 **highly significant at p 0.01 ***very high significant at p 0.001 IV Discussion The study findings revealed that the overall mean difference score of somatization disorder between the experimental and control group was 6.50. This clearly indicates that autogenic relaxation was an effective intervention in reducing the level of somatization disorder among chronic disease clients. This finding was consistent with the study conducted by Haftgoli N et al that found that 1217 patients had somatic complaints in which 917 patients exhibiting at least one physical symptom. The rate of somatoform disorders was 15.1% (95% CI = 12.8% to 17.5%) 7. The present study showed that chronic disease clients with increased age (F=2.486, p=0.060) had statistically significant association with the somatization disorder in control group. Results also revealed that other demographic variables had no significant association with the somatization disorder and biophysiologic parameters in experimental and control groups. The current study is limited because the researchers found difficulty in gathering the chronic disease clients for interventions. The researchers recommend that the Omayal Achi Community Health Centre implements this package along with wellness clinic and training must be given to the KIOSK members to implement autogenic relaxation in community settings. V Conclusion The study was aimed to assess the effectiveness of autogenic relaxation on somatization disorder and biophysiologic parameters among chronic disease clients. The findings revealed that, there was a significant reduction in the level of somatization disorder in the study group who received autogenic relaxation, when compared to the control group. The findings also indicated that the autogenic relaxation is a simple and cost effective intervention to reduce the level of somatization disorder among chronic disease clients. VI References 1. Waal MWMD, Arnold IA, Eekhof JAH, Hemert AMV. Somatoform disorders in general practice: Prevalence, functional impairment and comorbidity with anxiety and depressive disorders. The British Journal of Psychiatry. 2004Jan;184(6):470 6. 2. H H, H C, R L, G D. Somatoform disorders and medically unexplained symptoms in primary care. [Internet]. Deutsches Arzteblatt international. [cited 2015May30]. Available from: http://europepmc.org/articles/pmc4442550 3. Hoedeman R, Krol B, Blankenstein N, Koopmans PC, Groothoff JW. Severe MUPS in a sick-listed population: a cross-sectional study on prevalence, recognition, psychiatric comorbidity and impairment [Internet]. BMC Public Health. BioMed Central; 2009 [cited 2009Dec30]. Available from: http://paperity.org/p/57403332/severe-mups-in-a-sicklisted-population-a-cross-sectional-study-on-prevalence-recognition
80 http://www.iccrjnr.com Volume 2; Issue 1; Jan -Jun 2017 4. Patient Health Questionnaire - Wikipedia. (n.d.). Retrieved April & may, 2014 5. Kroenke K, Spitzer RL, Williams JBW. The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms. Psychosomatic Medicine. 2002;64(2):258 66. 6. Non pharmacological interventions for somatoform disorders and medically unexplained physical symptoms (MUPS) in adults [Internet]. Wiley. John Wiley & Sons, Ltd; 2014 [cited 2017May30]. Available from: http://onlinelibrary.wiley.com/doi/ 10.1002/14651858.CD011142.pub2/abstract 7. Haftgoli N, Favrat B, Verdon F, Vaucher P, Bischoff T, Burnand B, et al. Patients presenting with somatic complaints in general practice: depression, anxiety and somatoform disorders are frequent and associated with psychosocial stressors. BMC Family Practice. 2010;11(1). VII Source of Support The study was funded by International Centre for Collaborative Research (ICCR), Omayal Achi College of Nursing. VIII Conflict of Interests: None declared IX Acknowledgement We would like to thank the Village Leaders of Karani, Koduvalli, Kizhkondaiyar, Veerapuram and Lakshminathapuram, for granting permission to carry out this study and Dr.Rajanarayanan, Research Coordinator, ICCR for providing financial support for the study. X Contributors BS: Conceptualization of the study, collection, analysis of the data, writing the manuscript, and finalized the manuscript; JP: Conceptualization of the study, collection, analysis of the data, writing the manuscript, finalized the manuscript and will act as the guarantor of the paper; HJ,KS, CD: Edited and critically evaluated the manuscript.